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Aortic Valve Regurgitation

What is aortic valve regurgitation?

Aortic valve regurgitation describes the condition in which your aortic valve leaks. It's also called aortic insufficiency. The aortic valve is one of the heart’s 4 valves. These valves help the blood flow through the heart and out to the body. Normally, the aortic valve stops blood from flowing back into the left ventricle. With aortic valve regurgitation, some blood leaks back through the valve as the heart relaxes. Aortic valve regurgitation happens more often with age. It is a fairly common problem that affects both men and women.

Aortic valve regurgitation can be acute or chronic. With acute aortic valve regurgitation, the valve suddenly becomes leaky. The heart doesn’t have time to get used to the leak in the valve. With chronic aortic valve regurgitation, the valve slowly becomes leakier. This gives the heart time to get used to the leak.

What causes aortic valve regurgitation?

Aortic valve regurgitation can be caused by any condition in which the leaflets or the ring structure of the valve is damaged. This can occur with the following conditions:

Weakening and calcification of the valve from aging

High blood pressure

Defects of the aortic valve present at birth (congenital). This might be a bicuspid valve, instead of the normal tricuspid.

How is aortic valve regurgitation diagnosed?

Your healthcare provider will take your health history and give you a physical exam. Using a stethoscope, he or she will check for heart murmurs or congestion in your lungs. You may also have tests such as:

Echocardiogram (ultrasound of the heart), to make the diagnosis, assess severity and evaluate for a possible cause

Transesophageal echocardiogram (ultrasound of the heart taken from the esophagus), to further assess severity and evaluate for tearing of the aorta if needed

Stress testing may be advised to assess functional capacity

CT or MRI can also be used to assess for tearing of the aorta

MRI may be advised to assess severity and heart function if echocardiogram images are not ideal

Cardiac catheterization, aortography, or coronary angiography may be advised before aortic valve surgery or when initial testing provides unreliable data.

Electrocardiogram (ECG), to assess heart rhythm

Chest X-ray, can identify enlargement of the heart and aorta

How is aortic valve regurgitation treated?

Treatment varies according to how severe your condition is. If you have a mild form of the condition, you may need only regular check-ups with your healthcare provider. You may not have symptoms for many years. Symptoms may get worse slowly over time and not affect daily life.

In severe aortic regurgitation, surgery is commonly recommended. The timing of surgery is important to discuss with your healthcare provider and surgeon. In some cases, severe aortic regurgitation may be treated with medicine. Medicine may also be used in the short-term before valve replacement surgery. Or it may be used ongoing if you are not able to have valve replacement surgery.

It is also important to manage your blood pressure.

Medical treatment options may include:

Medicines to lower blood pressure and help the heart relax

Antiarrhythmic medicines to help maintain the heart’s rhythm

Water pills (diuretics) to reduce swelling

For people with severe aortic regurgitation, symptoms, enlargement of the left ventricle or abnormal pump function, the treatment is often somewhat different:

You may need surgery to replace the valve.

Your healthcare provider may recommend surgery even if you don’t yet have symptoms. People with advanced symptoms are less likely to recover well from the surgery. Because of this, it is important to closely follow up with your healthcare provider to make sure timing of surgery is appropriate for you.

You may need to take medicines until you have surgery.

Most people need an artificial aortic valve. In some cases, an aortic valve repair may be advised. The surgeon may do open surgery or may use a minimally invasive approach.

If you need heart surgery for another reason, your healthcare provider may advise aortic valve replacement at the same time.

Sometimes aortic valve regurgitation is acute:

Acute, severe aortic valve regurgitation needs surgery right away. You may need medicines for a short time to stimulate your heart or dilate your blood vessels.

In some cases, an infection of the heart valves can cause acute valve regurgitation. This may only need to be treated with antibiotics.

What are the complications of aortic valve regurgitation?

Complications are sometimes associated with aortic valve regurgitation such as:

Complications from valve replacement surgery

Blood clots that can cause heart attack or stroke

Bacterial infection of the heart valves

Heart failure

Sudden cardiac death

To reduce the risk of these complications, your healthcare provider may prescribe the following based upon your health history:

Medicines that prevent blood clots (blood thinners)

Medicines to help the pumping function of the heart

Living with aortic valve regurgitation

See your healthcare provider for regular checkups. Visit him or her right away if your symptoms change. Make note of your symptoms when you exercise. They may get worse during physical activity. It is common for symptoms to first be noticeable during exercise. Talk with your healthcare provider about your exercise habits. Tell all your healthcare providers and your dentist about your health history.